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260 Cards in this Set
- Front
- Back
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tuft of hair over spinal column
associated w/ spina bifida oculta |
faun tail nevus
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warty lesions in whorled or linear pattern
pigmented or skin colored skeletal, CNS, Ocular abnormalities |
Epidermal verrucus nevi
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Flat pigmented patches
>5 mm light to dark brown neurofibromatousous |
Café au lait patches
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Café au lait patches: other problems
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pulmonary stenosis, temporal lobe dysrhythmia, tuberous sclerosis
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what are some factors causing Provider level health care disparities (HCD's)
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bias/prejudice
lack of awareness clinical uncertainty beliefs/stereotypes about minority health/behevior |
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what are factors at the systems level causing HCD's
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lack of interpretation
time constraints geographic availabilaty to minorities changes in financing to deliver health care low minority representation in health profession |
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lack of access to health care among minorities attributed to...?
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cost of insurance - 72%
physician health care shortage area - FL |
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Factors causing HCD's at the Patient level?
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mistrust
literacy patient preferences cultural differences - care seeking behavior socioeconomic level |
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impact of cultural competency and equity
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technological/medical advances averted 117k deaths, if this were equalized to include AfAm. pop, 887k deaths would be averted
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provider and patient caused HCD
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negative outcomes in patient care due to mistrust and discrimination
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how to avoid/prevent provider/patient caused HCD
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develop empathy
sense of curiosity respect of other culture develop communication and negotiation skills |
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Mnemonic: ETHNIC
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Explanation - how do they explain it?
Treatment - what have they tried Healers - sought folk healers? Negotiate - discuss mutually acceptable options of treatment Intervention - how do they implement treatment Community - family, healers, community |
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Constraints in using an interpreter
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must be fluent in both languages
not a family member/ no bias/constraint not a child to the patient (inversion of power) |
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Triadic interview tips
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interpreter is a professional
focus on Pt ask PT to repeat instructions |
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6 Focus areas of HCD among minorities
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Infant mortality
Cancer screening/treatment Cardiovascular disease (CVD) Diabetes HIV/AIDS Immunizations |
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over arching goals of Healthy People 2010
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1) Increase quality and years of healthy life
2) Eliminate health disparities |
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Skin functions
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protection
regulate hydration, temperature, Blood pressure Sensory input Vitamin D Excrete sweat, urea, lactic acid express emotion |
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Skin exam general questions
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how long has it been present
how does it behave how did it start how did it look initially what effects it treatments travel |
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assess symptoms skin exam
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does it itch, burn, sting?
is it painful, sore, tender? |
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Related Skin exam questions
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past Hx of skin/ related disorders
FHx Sx Associated Hx medications, current/past occupation effect of disease on patient |
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how to perform skin exam
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expose skin
get big picture pattern view individual lesions |
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what do you assess on the skin during skin exam?
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Color
Moisture Temperature Texture Mobility & turgor Lesions |
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what does color tell you about skin condition? Pigmentation
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increased pigmentation - addison's
Loss of pigmentation - tinea versicolor, vitilligo, post inflamm. hypomelanosis, tuberous sclerosis |
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what can skin condition tell you about a PT? Color: pallor, redness, cyanosis, yellowing
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red: increase oxyhemoglobin
pallor: decrease oxyhemoglobin cyanosis: increase deoxyhemoglobin yellow: Jaundice or carotenemia (liver function) |
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what can skin condition tell you about a PT? dryness, oily, moist
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dry - hypothyroidism
oily - acne sweating |
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what can skin condition tell you about a PT? temp
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general warmth: fever, hyperthyroidism
local warmth: inflammation coolness: hypothyroidism |
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what can skin condition tell you about a PT? texture
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rough - hypothyroidism
smooth - hyperthyroidism |
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what can skin condition tell you about a PT? mobility
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decrease mobility: edema or scleroderma, scaring
decrease turgor: dehydration |
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macule
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flat
<1cm 1 ° lesion |
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patch
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flat
>1cm 1 ° lesion |
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papule
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raised
<1cm 1 ° lesion |
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plaque
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raised
>1cm 1 ° lesion |
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nodule
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deep in dermis
raised 1-2cm |
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Vessicle
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fluid filled papule
<1cm 1 ° lesion |
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Bulla
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fluid filled plaque
>1cm 1 ° lesion |
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Wheal
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edematous papules/plaques
usually pruritic 1 ° lesion |
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telangiectasia
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dilated cappilaries
1 ° lesion |
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Crust
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dried exudate
2° lesion |
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Excoriation
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shallow excavation from scratching
2° lesion |
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lichenification
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thickening with exaggeration of creases
2° lesion |
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erosion
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loss of epidermis
depressed moist follow rupture of vesicle or bulla eg. varicella, variola after ruputre |
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Scale
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sebhorrheic dermatitis post scarlet fever
drug rxn dry skin |
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lichenification
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chronic dermatitis
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keloid
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excessive scar formation - excessive collagen formation
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scar
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healed wound
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excoriation
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abrasion/scratch
scabies |
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lesion morphology. what to look for
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color
scale shape pattern surface consistency margin |
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patterns
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linear
annular target dermatomal (nerve root area) |
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etiologies of skin dieseases
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neoplastic
microbiologic immunologic nutritional genetic chemical physical hypoxia |
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tools for skin assessment
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KOH and Microscope - skin scrapings
Woods lamp - fungal infex 360nm wavelength |
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layers of epidermal skin from outermost to innermost
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stratum corneum
stratum lucidum stratum granulosum stratum spinosum stratum germinativum |
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where are keratin cells formed
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stratum germinativum
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location of melanocytes
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germinativum
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function of melanocytes
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make melanin
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layer just deep to stratum germinativum
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papillary layer of dermis
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fiber types found in dermis
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elastin, collagen, reticulum fibers
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location of sensory fibers
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dermis
pain touch temperature |
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location of arrectores pilorum muscles
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dermis
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functions of hypodermis
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adipose layer generates heat, insulation, shock absorption, and is a reserve of calories
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locations and function of Eccrine sweat glands
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opens to surface of skin to regulate body temp with water secretion
distribution throughout body except lip margins, eardrums, nail beds, inner surface of prepuce, glans penis |
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glands found in axillae, nipples, areolae, anogenital area, eyelids, and external ears
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apocrine glands
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location of apocrine glands
function |
deeper than eccrine sweat glands
respond to emotional stimuli |
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apocrine secretion composition
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white protein, carbohydrate, and other substances
odorless bacteria causes the odor |
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glands that secrete lipid rich substance to prevent dehydration of hair and skin
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sebaceous glands
sebum |
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stimulation of sebaceous glands
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testosterone
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who has fewer apocrine sweat glands?
Caucasian Asian native am Af Am/African |
Whites and Af Am/Africans have more functioning apocrine sweat glands
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where is hair formed
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in epidermal layers invaginated into dermal layers
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hair is formed of???
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root, shaft, follicle
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what makes the hair color
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melanocytes
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types of hair
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vellus - short, fine, soft, nonpigmented
terminal - courser, longer, thicker, pigmented |
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three stages of hair growth
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anagen - growth
catagen - atrophy telogen - rest |
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cuticle of nail is composed of what skin layer
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stratum corneum
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lanugo hair, what is this?
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fine silky hair, particularly covering shoulders and back of newborn's body
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what is vernix caseosa
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mix of sebum and cornified epidermis covering an infant's body at birth
cheese? |
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what is a common cause of acne and other potentially embarrassing problems in adolescents
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increased sebum production in sebaceous glands in response to increased androgen - causes oily skin
enlarging apocrine glands become active - increased axillary sweat - body odor |
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common skin change characteristics of a pregnant woman
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skin thickens, fat deposited in subdermal layers
skin darkening - in face, nipples, areolae, axillae, vulva, perianal skin, umbilicus (new nevi and growth of old nevi) |
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common skin changes in elderly
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decreased sebaceous gland activity - drier skin
thinning epidermis less elastic dermis - wrinkles decreased subcutaneous tissue loss of pigmentation in hair - decreased functioning melanocytes loss of pubic hair slower nail growth - thicker toenails |
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if hair is lost in peripheral extremities, what potential diagnosis be could be made
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peripheral vascular disease
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loss of axillary and pubic hair is indicative of what?
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diminished androgen production
- normal, occurs with age |
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screening for sunscreen - common risk of use?
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not used enough and PT thinks they are protected
stay in sun too long do not reapply |
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what is important to remember when inspecting skin lesions?
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adequate lighting
visual sweep of entire body compare sun exposed to non sun. remove coverings intertriginous areas |
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traditional health practices often confused with physical abuse
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coining - coin in mentholated oil rubbed vigerously - dermabrasion
cupping - small heated glasses placed on skin - red circular mark |
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features of Halo nevus
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sharp, oval or cirucular, depigmented halo around mole
morphologic changes usually on back usually benign biopsy because same process occurs around melanoma |
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intradermal nevus, features
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dome shaped
flesh to black color hairy limited to dermis benign, no need to remove |
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Junction nevus, features
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flat, elevated, dark brown
line dermoepidermal junction removed if exposed to repeated trauma |
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compound nevus, features
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elevated brownish papule
indistinct border in dermis and dermoepidermal junction removed if trauma persists |
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hairy nevous, features
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present at birth
remove if changes occur |
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normal mole features:
color shape surface size number location |
tan/brown - all tend to look similar
round/oval clear defined border flat/smooth/raised bump less than 6mm frequency - 10- 40 all over body usually above waist on sun exposed surfaces (rarely on buttocks) |
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Dysplastic mole features:
color shape surface size number location |
mixture of colors (tan, black, pink, red) not all the same on one person
irregular borders, inclued flat portion level with skin smooth, scaly, rough (pebbly) often -larger than 6mm, sometimes - larger than 10mm low population typically, advanced/severe case - more than 100 moles commonly found on back below waist line scalp, breast, buttocks |
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Cutaneous Color changes
brown cause, some conditions |
darkening melanin pigment
pituitary, adrenal, liver disease - generalized area nevi, neurofibramatosis - localized |
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define dysplastic
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abnormality of development
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cutaneous color changes:
white features and associated conditions |
absence of melanin
albanism - generalized vitiligo - localized |
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cutaneous color changes:
red (erythema) features and associated conditions |
increased cutaneous blood flow
inflammation - localized fever, viral exxanthem, urticaria - generalized |
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cutaneous color changes:
Yellow features and associated conditions |
1. increased intravascular RBC's -
generalized - Polycythemia 2. increased bile pigmentation (jaundice) - generalized - Liver disease inc. carotene pigmentation - generalized (except sclera) - hypothyroidism, increased intake of vege's |
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cutaneous color changes:
BLUE features and associated conditions |
unsaturated hemoglobin secondary to hypoxia
Lips, mouth, nail beds, Conjunctiva cardiovascular pulmonary disease |
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define Ecchymoses
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discolorations produced by injury to tissue (often blue, black, green)
Bruise non-blanchable cause: vascular wall destruction, trauma, vasculitis |
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define petechiae
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discolorations due to causes other than injury
<0.5 cm |
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define Purpura
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discolorations due to causes other than injury
>0.5 cm in diameter often found in elderly persons - blue/purple non-blanchable cause: intravascular defects, infex |
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how do you tell the difference between a vascular spider and a telangiectasia
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telangiectases are masses of venules that refill erratically when blanched
vascular spiders are arterial they refill in an organized manner when blanched |
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spider angioma
cause features |
central red body with radiating spiderlike branches
blanches with pressure to center cause: liver disease vitamin b deficiency idiopathic |
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venous star
features causes |
bluish spider
does not blanch with pressure Cause: increase pressure in superficial vv. |
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Telangiectasia
features causes |
fine irregular red lines
cause: dilated capillaries |
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Capillary hemangioma
feature cause |
red irregular macular patches
Cause: dilation of dermal capillaries |
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smell of clostridium gas gangrene
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rotten apples
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smell of proteus infection
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mousy
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smell of pseudomonas infex
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grapelike
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smell of Schizophrenia
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pungent
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smell of tuberculous lymphadenitis (scrofula)
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stale beer
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Smell of scurvy
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putrid
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smell of intestinal obstruction, peritonitis
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feculent
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smell of phenylketonuria
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mousy/musty
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Pt has been poisoned with mercury at a sushi bar, what are some signs
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presents with red flush or widespread milarial rash
not feeling well sweating profusely |
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how to assess turgor
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pinch forearm or skin over clavicle/ sternal area
assesses hydration in patient if the skin remains tented - dehydrated |
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a primary skin lesion is_______
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spontaneous manifestation of a pathological process
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a secondary skin lesion is ______
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a result from the evolution of or a trauma to the primary skin lesion
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PT presents with a flat reddish lesion 5mm in diameter. classify:
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macule
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Pt presents with flat brown lesion on back near buttocks 6cm by 7 cm. classify:
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patch
could be mongolian spots |
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pt presents with itchy raised reddish shiny lesions on legs bilaterally, each lesion is less than 1 cm in diameter . classify
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papule
likely lichen planus |
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pt presents with elevated firm rough lesion with flat surface greater than 1 cm. classify
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plaque
if scale develops, probably psoriasis could be seborrheic or actinic keratosis |
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pt presents with elevated irregular shaped lesion.
solid, transient, and variable diameter |
Wheal
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Pt presents with firm lesion. feels deeper in dermis than a papule. it is 2 cm in diameter. classify
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Nodule
could be lipoma, or erythema nodosum |
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Pt presents with elevated solid lesion, no clear demarcation. deep in dermis. Size: 5 cm. Classify
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Tumor
neoplasms, benign tumor, lipoma |
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Pt presents with elevated circumscribed superficial lesion. Doesn't feel as deep as dermis and is filled with SEROUS FLUID. Small. about 5mm. Classify
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Vessicle
Varicella (chx pox) herpes zoster (shingles) |
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pt also has some lesions that look like her vessicles, but are a little larger. 1 - 2 cm. Classify.
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Bulla
blister pemphigus vulgaris - blistering autoimmune skin disease |
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pt presents with elevated superficial lesion. similar to a vessicle, but filled with purulent fluid rather than serous. classify
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PUSTULE
impetigo acne |
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PT presents with elevated well defined skin lesion. Located in the dermis or subcutaneous tissue. Filled with fluid or semi solid material
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Cyst
sebaceous cyst cystic acne |
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Pt presents with fine irregular red lines from what appears to be capillary dilation
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telangiectasia
Telangiectasia in rosacea |
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Pt has roughened raised skin over a previous lesion
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lichenification
chronic dermatitis |
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Pt has dried serum blood over skin lesion
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Crust
secondary skin lesion Scab on abrasion exzema |
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Pt has a linear skin lesion following a nerve along T4. Mophologic characteristic
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Zosteriform (dermatomal
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PT presents with Maculopapular lesions that become confluent on body and face. morphology
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Morbilliform
measles roseola |
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Female pt presents with terminal hair growth on face in a male distribution pattern
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Hirsutism
endocrine disorder |
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caucasian Male PT presents with dark band on index finger nail bed. Suspect _____
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melanoma
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obese 60 yo F. Pt presents with yellowing nails. smoker since 12 yo. Suspect ______
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Chronic respiratory disease
could also be psoriasis or fungal infection |
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Pt has proximal subungal infection. Homosexual. Suspect ____
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HIV
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pt has lost his nail. what is this called
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Anonychia
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pt complains of inflammation around the nail bed. classify
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paronychia
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pt presents with transverse rippling of the nail.
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Transverse grooving
Beau lines habit tick deformity repeated injury to nail from thumb |
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Pt. presents with broadening and flattening of the nail plate. Suspect ______
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syphilis
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if a patient has chronic pulmonary and cardiovascular problems, what would be a consistent characteristic in the nails
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Clubbing
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a patient presents with apparent clubbing of the fingers, what test do you perform? what accompanies clubbing in your physical exam?
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Shamroth test
boggyness in nail base |
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pt presents with pain in the fingernail groove. what do you suspect?
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pain is secondary to ischemia
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if your PT has a nails that easily separate from the nail bed, what do you suspect?
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psoriasis, trauma, candidal, or pseudomonas infections
some medications |
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PT presents with spoon nail; aka ____ ?
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koilonychia
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PT is 5 min. old, what are expected color changes?
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Acrocyanosis
Cutis marmorata Erythema toxicum Harlequin color change mongolian spots telangiectatic nevi (stork bites) |
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describe acrocyanosis
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cyanosis of hands and feet
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describe erythema toxicum
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pink papular rash superimposed with vessicles over thorax, buttocks, abdomen
appears in 24 - 48 hrs. resolves over several days |
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describe harlequin color change
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clear outlined color change when infant is laying on side
dependent lower half is pink, upper 1/2 is pale |
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describe mongolian spots
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deep blue irregular pigmentation
sacral and gluteal regions Af Am, Native am, Asian, latin descent |
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what are telangiectatic nevi
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flat, deep pink localized areas on back of neck
stork bites |
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what are risk factors in hyperbilirubinemia?
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breast feeding - ßgluconidase
cephalhematoma, sub/cutaneous bleeds infrequent feeding hemolytic disease infex |
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1 yo pt presents with warty lesions in whorled pattern. skin colored. what do you suspect?
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Epidermal verrucous nevi
central nervous system, skeletal, and/or ocular abnormalities |
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pt. presents with flat evenly pigmented spots varying in color from light brwn to dark brown, at birth. what do you suspect?
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cafe au lait patches
neurofibromatosis pulmonary stenosis temporal lobe dysrhythmia tuberous sclerosis |
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what may occur in conjunction with cafe au lait patches in the axillary or inguinal areas? what is indicated by this?
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Freckling
neurofibromatisos |
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pt presents at birth with large flat red pigmented lesion across R side of her face. What do you suspect? Possible omplications?
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Facial port wine stain
if involving trigeminal nerve - ocular defects (eg Glaucoma) |
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if port wine stain is present and malformation of meninges has been discovered, what is the syndrome name? Effect on brain?
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Sturge-Kalischer-Weber Syndrome
results in atrophy and calcification of adjacent cerebral cortex |
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Klippel-Trenaunay-Weber Syndrome presents with what characteristics?
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Port wine stain on trunk/limb
venous varicosities and hypertorphy of underlying soft tissue/bones bleeding limb hypertrophy orthopedic problems |
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What to suspect when pt presents with congenital lymphedema (w/ or w/o hemangioma)
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Turner syndrome
gonadal dysgenesis XO karyotype |
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What to suspect when PT presents with supernumerary nipples
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Renal abnormalities
particularly in whites |
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What is the "hair collar" sign?
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ring of long dark course hair surrounding midline scalp nodule in infants
indicates neural tube defects of scalp |
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What to suspect when PT presents with persistent pruritis?
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in absence of skin disease
DM, chronic renal failure, cholestatic liver disease, hodgkin disease |
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What are the characteristics of cutis marmorata?
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mottled appearance when newborn is exposed to changes in ambient temperature. (cooling or heating)
More common in premature infants and Down syndrom and hypothyroidism |
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what is milia?
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small whitish papules on face of newborn
first 2-3 mos of life sebaceous glands are immature easily plugged with sebum |
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Fullterm Newborn PT presents with tiny yellow macules on forehead, cheeks, nose, and chin. What is this? Cause? Rx?
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Sebaceous hyperplasia
from androgen stimulation by mother quickly resolves in 1-2 mos |
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Mnemonic for those at risk of malignant melanoma
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MMRISK
Moles (atypical, dysplastic) Moles (numerous) Red hair & freckling Inability to tan Sunburn (esp. childhood) Kindrid - family history |
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most common skin cancer? appearance
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basal cell carcinoma
papule or plaque, shiny, on face... |
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appearance of squamous cell carcinoma
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erythmatous papule or plaque with scale (sometimes yellow scale)
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a young PT presents with what looks like child abuse. Very red cheeks. the mother tells you another child in the PT's class had some virus and was feverish, just as her son. What do you suspect?
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Fifths disease
aka. Erythema infectiosum aka. Parvovirus B19 |
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PT presents with hyperpigmentation on lips and oral mucosa. He has been having GI problems recently. What do you suspect?
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Peutz-Jeghers syndrome
association with GI polyps |
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What is chloasma? Is it rare?
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Choasma/ melasma
mask of pregnancy 70% of pregnant women darkened skin found on forehead, cheeks, nose, chin |
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is palmar erythema common in pregnant women? when does it resolve?
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common
diffuse redness on palmar surface disappears after delivery |
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What might cause itching during pregnancy?
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on abdomen and breasts - stretching of skin
impaired bile flow - jaundice more severe on palms and soles |
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Why are the elderly more susceptible to decubitious ulcers?
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1. thiner skin
esp. over bony prominences 2. decrease in vascular circulation |
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your 80 yo PT presents with a bed sore over her PSIS. It appears that there is damage through to the subcutaenous tissue. What is the stage?
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Stage III
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how do you stage decubitus ulcers?
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4 stages
I. Skin is red, not broken II. Damage through epidermis and dermis III. Damage through to subcutaneous tissue IV. Muscle and possible bone involvement |
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your PT presents with a cherry angioma, how is this described?
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tiny, bright, ruby red, papule
appear on virtually everyone after 30 yo |
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What does a seborrheic keratoses look like?
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pigmented raised warty lesions
usually on face or trunk important to distinguish b/t actinic keratosis (malignant) |
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How does a sebaceous hyperplasia present?
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yellowish, flattened papule with central depression
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what is an Acrochordon
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cutaneous tags
small soft skin tags appear on neck and upper chest pigmented or not |
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What are lentigines?
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Senile Lentigenis aka age spots
irregular, round, gray-brown lesions with rough surface occur in sun exposed areas |
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why does an older person's hair turn gray?
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melanocytes cease functioning
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pt presents with a white, smooth hard elevated painful lesion on sole of foot. located over the ball of her foot between the 4th and 5th toes. what could it be?
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Corn
two types - soft - caused by bony prominence over soft tissue whitish thickening b/t 4th and 5th toes. Hard - conical appearance sharp delineation shoe pressure on IP joints |
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A concerned construction worker presents in your office with a malignant melanoma. You also notice his hands are rough and has marked, non-tender/ non-painful hyperkeratosis at the MCP/IP joint. What are these thickenings?
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Callus
found on feet as well usually not tender |
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what is the common factor for contact, allergic, and atopic dermatis? and what is it a result of?
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epidermal breakdown is commonality
results from intracellular vesiculation |
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A young PT presents with thick lichenified, pruritic plaques surrounded by erythematous region in the popliteal fossa. Some pruritic weeping vesicles are present What do you suspect?
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Chronic atopic dermatitis with an acute phase present
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What are the three stages of eczematous dermatitis?
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Acute
Subacute Chronic |
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What are the characteristics of the three stages of eczematous dermatitis?
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Acute - erythematous, pruritic, weeping vessicles
excoriation predisposes PT to infection and crust formation Subacute - erythema and scaling; itching may not be present Chronic - thick, lichenified pruritic plaques |
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a PT presents in your office with red, hot and tender edematous skin over a region of his thigh. In the center there is a small puss filled perifollicular abscess. What do you suspect?
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Furuncle
aka Boils an acute localized staphylococcal infection |
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A 30 yo male PT presents with small pustules in his beard hair. You notice some crust formation over what looks like ruptured pustules. What is this?
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Folliculitis
staphylococcal infex of hair follicle and surrounding dermis |
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a pt presents with diffuse acute infection of the skin over L shin after a fall. The skin is erythematous, hot, tender and INDURATED. Lymphangitic streaks are noted. what is this?
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Cellulitis
a streptococcal or staphylococcal infection of the skin and subcutaneous tissue |
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What are the 5 tinea infections associated with different regions of the body?
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Tinea corporis - non hairy regions of body
tinea cruris - inner thigh and groin tinea capitis - scalp tinea pedis - foot tinea unguium - nails |
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what type of infection is tinea (aka dermatophytosis)?
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it is a noncandidal fungal infection that affects stratum corneum, nails or hair
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what appearance do Tinea infections have?
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papular, pustular, vesicular, erythematous, or scaling
secondary bacterial infex may be present |
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What does this pt have? She presents with sudden onset of a round pale, erythematous plaques with fine, superficial scaling. A large herald patch is found on her lower R quadrant on her back. There is a characteristic Christmas tree pattern.
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Pityriasis Rosea
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is pityriasis rosea contageous?
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No.
not infectious or contagious |
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A 54 yo male PT presents in your office with dry silvery scaling papules and plaques over his L thigh and leg. He also has some lesions on his back and buttocks, and a small lesion on his scalp. What does he have?
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Psoriasis
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What is Psoriasis
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chronic recurrent disease of keratin synthesis
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what is pityriasis rosea?
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an idiopathic self limiting inflammation
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an elderly male pt presents in your office with Rhinophyma (tissue hypertrophy of nose). His nose is erythematous and you note some telangiectasia. What do you suspect?
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Rosacea
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What is rosacea
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chronic inflammatory skin disorder
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what is rhinophyma
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sebaceous hyperplasia, redness, prominent vascularity and swelling of skin of the nose
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how do you treat rosacea?
what is the treatment for rhinophyma? |
Rosacea - antibiotics
Rhinophyma - surgery |
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your pt presents in your office with discrete erythematous maculopapules on his trunk, extremities, and palms a few days after you prescribed a sulfadrug. You note the presence of pruritis. What is wrong?
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drug eruption
usually drug eruptions fade in 1-3 weeks |
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a 60 yo female presents with red swollen plaques and vesicles filled with Purulent fluid in a linear pattern along T4 dermatome. She tells you that she had itching, burning, painful sensations in that area 4 or 5 days ago. What is this?
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Herpes Zoster
aka Shingles |
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what is herpes zoster?
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a viral infection of a single dermatome
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a 25 yo male pt presents to your office with crusting erythematous lesions around his oral cavity after a "crazy weekend in vegas". he said he partied with "some random girls" all weekend. he also has some similar looking vesicles on his penis. What does he have?
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HERPES simplex
Type 1 - oral infection Type 2 - genital infection |
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how long does herpes simplex last?
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vesicles form with erythematous base, erode, and then form a crust. the lesions last from 2 - 6 weeks
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after a biological warfare attack, what two cutaneous manifestations would you look for in the population?
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Cutaneous Anthrax
Smallpox |
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describe cutaneous anthrax
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1. spore forming bacterium bacillus anthracis
2. not communicable person to person 3. incubate up to 12 days 4. macule or papule enlarges to round ulcer by day 2. Central necrosis develops. accompanied by vessicles with serosanguinous fluid. 5. lymphangitis, lymphadenopathy possible |
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small pox description
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1. direct transmission by saliva
1st week most infectious infectious till all scabs are gone 2. incubation time: 12 days 3. rash appears 2-3 days after systemic symptoms oral mucosa first, then face and forearms, spread to trunk and legs starts with red flat lesions and mature in crops lesions become vessicular, then pustular, then crust 4. systemic symptoms: high fever, fatigue, headache, backache |
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What are the 5 warning signs of basal cell carcinoma
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open sore - doesn't heal in 3 wks
reddish patch - crusts or itches shiny nodule - pearly or translucent pink growth - slightly elevated border and indented center. blood vessels on surface scarlike area - white, yellow, or waxy with poor defined borders |
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what is the most common form of skin cancer? is it malignant?
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Basal cell carcinoma.
MALIGNANT |
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where is basal cell carcinoma found?
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arises in the basal layer of the epidermis on the face, ears, neck, scalp, shoulders, and back
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what is the second most common form of skin cancer? is it malignant?
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squamous cell carcinoma
MALIGNANT |
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what are the 4 warning signs of squamous cell carcinoma?
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wartlike growth that crusts and bleeds
persistent scaly red patch - irregular borders open sore that bleeds for weeks elevated growth with central depression |
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What are the 11 risk factors for developing basal or squamous cell carcinoma?
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Age - 50 or older
Chronic sun exposure Fair skin Light colored hair/eyes Sunburn easy Blistering burns as child Geographic location - equator Exposure to tar, arsenic, creosote, coal, petroleum products Overexposed to redium, radio isotopes, Xrays Repeated trauma or irritation to skin Precancerous dermatosis |
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What are the ABCDE's of melanoma?
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Assymetry of lesion
Borders are irregular or blurred Color is not same over all - Red, white, blue, brown black patches Diameter - Greater than 6 mm or is growing larger Elevation |
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What do melanoma's develop from?
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Malignant melanocytes
migrated to skin, eye, CNS, mucous membranes during development |
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What are the 5 highest risk factors for Melanoma?
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Previous history of melanoma
Mole changing rapidly Dysplastic nevi and family history of melanoma (1st degree relative) Several dysplastic or atypical nevi |
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What are the 6 increased risk factors of melanoma
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greater than 50 nevi
large congenital nevus (greater than 15 cm) immune suppression fair skin sever blistering as child inability to tan |
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An AIDS pt presents with soft vascular, bluish purple, painless lesions on her feet and hands between her digits. She has noted GI problems, and you also notice some yellowing of her eyes. What do you suspect
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KS
Karposi Sarcoma |
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three types of alopecia
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alopecia areata
scarring alopecia traction alopecia - prolonged stress on hair. inflamed scalp |
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female PT presents with terminal hair growth in a male pattern distribution on her face, body, and pubic areas. what do you suspect?
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Hirsutism
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Pt has inflammation of the paronychium. what is this called?
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paronychia
redness and swelling tenderness at lateral and proximal nail folds |
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what is koilonychia? clinical significance?
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spoon nails
iron deficiency anemia, syphilis, fungal dermatoses, hypothyroidism |
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What are beau lines? clinical significance?
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stress interrupting nail formation
transverse depression at lunulae in all nails associated with coronary occlusion, hypercalcemia, skin disesase |
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what is tinea unguium?
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fungal infection of the nail
4 distinct patterns distal nail plate turns yellow and hyperkeratotic debris accumulates onycholysis - seperation of nail from bed |
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what is an ingrown toenail?
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painful piercing of the nail into the lateral nail fold
grows into dermis swelling |
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What is subungal hematoma?
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trauma to nail plate causing bleeding
possible onycholysis and loss of nail |
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what is leukonychia punctata?
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white spots on nail plate from minor injury
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what is Habit-tic-deformity?
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horizontal sharp grooving extends to tip of nail
from picking at proximal nail fold |
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what is onycholysis?
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seperation of nail plate from bed
cause: minor trauma, psoriasis, candida or pseudomonas infex, allergic contact dermatitis, hyperthyroidism |
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what is koilonychia? causes?
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spoon nails
iron deficiency, syphilis, fungal dermatoses, hypothyroidism |
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what are Terry nails? cause?
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aka White banding
transverse white bands cover entire nail except distal tip cause: cirrhosis and hypoalbuminemia |
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What nail problems are associated with psoriasis?
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nail pitting
onycholysis discoloration subungal thickening splinter hemorages |
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what are warts?
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epidermal neoplasms caused by viral infection
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what are digital mucous cysts?
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cysts with clear jelly like substance
dorsal surface of distal phalanx longitudinal nail groove may appear from cysts |
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what is PUPPP
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pruritic urticarial papules and plaques of pregnancy
arises 3rd trimester of 1st preg. begins on abdomen spreads to extremities periumbilical sparing |
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if a child under age 5 presents with more than 5 patches of Cafe au lait, what does this suggest?
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Neurofibromatosis
aka von Recklinghausen disease |
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what is seborrheic dermatitis? causes?
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chronic recurrent erythematous scaling eruption localized in areas of sebaceous glands
(scalp, back, intertriginous and diaper area) aka Cradle cap - scaling, adherent, thick, yellow, crust can spread over ear and nape of neck elsewhere - lesions are erythematous, scaling, and fissured |
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what is prickly heat? cause?
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aka Miliaria
irregular red macular rash occluded sweat ducts during high heat and humidity often seen in summer time |
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what is impetigo? cause?
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highly contageous staphylococcal or strepococcal infex of epidermis
pruritis, burning, regional lymphadenopathy initial lesion is small erythematous macule changes to vessicle or bulla crusts with honey color |
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what is acne vulgaris? causes?
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seen in adolexcents
inlamed lesions involve stagnation of sebum and comedo formation in pilosebaceous follicles with bacterial invasion |
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a 4 mo old boy presents with a reddened plaque on his forehead. what is this? can it be found elsewhere? treatment?
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reddened patchiness
found on nape of neck, eyelids, forehead, upper lip causes: capillary hemangiouma, nevus flammeus, nevus vasculousus, telangiectatic nevus usually dissapear by 1 y of age may reoccur as addults |
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What is varicella?
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aka Chickenpox
highly communicable varicella zoster virus fever mild malaise pruritic maculopapular skin eruptions starts on scalp and trunk and spreads centrifugally to extremities |
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What complications are possible with varicella?
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conjunctival involvement
secondary bacterial infex viral pneumonia encephalitis aseptic meningitis myelitis guillain barre syndrome reye syndrome |
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What is rubeola? characteristics?
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aka measles
highly communicable viral disease prodromal fever, conjunctivitis, coryza, and bronchitis blotchy red rash follows Koplik spots on buccal mucosa macular rash develops on face and neck lesions become maculopapular in 24-48 hr spread to trunk and extremities lasts 4-7 days incubation 10 days communicability - few days before fever to 4 days after appearance of rash mild to severe symptoms |
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complications of rubeola?
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respiratory tract infex
CNS infex |
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What is rubella? characteristics?
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aka German Measles
highly communicable viral disease pink to red maculopapular rash prodromal mild febrile period, coryza, sore throat, cough appearance of macular rash on face and trunk rapidly becomes papular spread to extremities fades in 3 days incubation 14 - 23 days communicability - 1 week prior to 4 days after rash |
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what are Forshheimer spots?
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reddish spots on soft palate during prodrome or first day or Rubella rash
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complications of rubella?
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if infected during 1st trimester of pregnancy - congenital anomolies for child
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if a 4 yo female presents in your office with diffuse irregular hair loss on one side of her scalp and an obstruction in her stomach, what do you suspect?
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trichotillomania with trichobezoar
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what is trichotillomania?
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manipulation of hair
usually unconscious |
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what is trichobezoar
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large obstructive lump of hair in stomach that forms after child swallows hair
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what are some patterns of injury in physical abuse?
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bruises - patterned with implement used; soft tissue involvement
burns - immersion, absence of splash marks, cigarette burns lacerations - frenulum: suspect force feeding scars bony deformities alopecia - in absence of scalp disorder; indicate hair pulling retinal hemorrhages dental trauma head abdominal injuries |
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2 Common skin disorders in the elderly?
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Stasis dermatitis
solar keratosis (senile actinic keratosis) |
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what causes stasis dermatitis? characteristics
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secondary to edema of chronic peripheral vascular disease
character: lower legs and ankle involvement erythematous scaling, weeping patches |
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what causes senile actinic keratosis? characteristics?
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aka. solar keratosis
secondary to chronic sun damage raised irregular, rough surface usually on dorsal hand, neck, arms, face Malignant potential |
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most common form of elder abuse?
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neglect
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history taking essentials when abuse is suspected?
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ask direct questions
"is anyone hurting/harming you? have you been confined against your will? question PT in private away from family members or caregivers Determine mental status - abuse may be present, but must be corroborated |
